RemoteDB Gateway -- User Registration Form


1. User information:

Name: ___________________________________________________________
Title: __________________________________________________________
Company: ________________________________________________________
Address: ________________________________________________________
City: ___________________ State: _____________ ZIP: _____________
Country (if other than US): _____________________________________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
E-mail address (optional): ______________________________________


2. Server Information

When you register the software, a license key will be distributed
that will activate the software for the registered number of users.
The license is only valid on a single computer.  To generate this
license key, the author will need to know the IP address for the
computer on which the RemoteDB Gateway server software will be
installed.  If you know this information at this time, please enter
it in the space provided below and a license key will be generated
and sent along with the software distribution.

IP Address: _____________________________________________________

If you do not happen to know this information, a license key will
not be generated until this information becomes available.  You may
either call or E-mail the author and a license key will be distributed.
Please be sure to properly identify yourself when making the request.


3. Shipping and Handling (check one):

__ E-mail ZIP file to: __________________________________________
__ 3 1/2" DS/DD disks


4. Payment and fees:

Fees are in U.S. dollars, payments must be made in checks
or money orders drawn on U.S. banks. Payment must be mailed
together with this form.  Make checks or money orders payable to:

   Michael McDonald

Check all that apply and fill in the blanks:

__ One registered copy of RemoteDB Gateway.................$ 25.00
__ 5-User License..........................................$ 90.00
__ 10-User License.........................................$150.00
__ 25-User License.........................................$300.00
__ 50-User License.........................................$450.00
__ Additional Licenses (__ Users @ $8.00/User).............$______
__ U.S. Shipping and handling (if other than E-mail).......$  4.00
__ Non U.S. Shipping and handling (if other than E-mail)...$  6.00

Total:.....................................................$______


5. Mail this form together with payment to:

   Michael McDonald
   2506 Branding Iron Ct.
   Herndon, VA 20171
   USA


6. Software Distribution

Once payment has been received, a license key that activates the software
for the requested number of users along with the current version of the
software will be distributed.  This distribution will typically occur
within 24 hours of payment receipt.  For the fastest service, please check
E-mail as the preferred means of software distribution.